What is infertility?
Infertility means that there is difficulty in conceiving a child. Problems can arise because of the man's reproductive system, the woman's, or a combination of both. Many infertile couples have primary infertility, which means they were never able to conceive. Some people however have secondary fertility, which means they are having trouble conceiving even though they already have children.
For a fertile couple in their twenties having regular unprotected sex, the chance of conceiving each month is only 20- 25 per cent. So how do you know when something's amiss? The answer depends on how old you are. While the age of the man is thought to play a role, the medical definition of infertility focuses on the woman. Those under 35 are advised to seek treatment for infertility if they haven't become pregnant after 12 months of regular unprotected sex. For those over 35, the threshold is six months instead of 12.
But there are degrees of infertility. The majority of infertile couples are actually sub fertile – that is, they produce eggs and sperm but have difficulty conceiving due to disorders such as hormone imbalances and problems with the reproductive tract. Cases of total infertility – where no eggs or sperm are produced – are rare.
After 12 months of trying to conceive, you should consult your gynecologist for a referral to a fertility specialist. A series of tests will need to be performed on you and your partner. They will give clues to the particular cause of your infertility and ultimately a treatment plan to overcome the problem.
Firstly, the specialist will look at both your medical histories. For the woman, this includes any previous pregnancies, regularity of periods, painful periods, pelvic pain, infections, or surgery. For the man this will include whether he has fathered children previously, testicular injury, developmental problems, infections, surgery and exposure to certain environmental factors.
Physical examination will also be performed Other test which may include:
Sono salphingography or hysterosalpingography or Surgical laparoscopy may also be used to identify blocked fallopian tubes or endometriosis.
Types of Infertility
For centuries, if a couple were unable to have a baby, the problem was deemed to be with the woman. It is now known that both men and women suffer infertility problems and they are no more common in one sex than the other. Sometimes multiple factors are involved in one or both partners.
Women can suffer from disorders such as hormone imbalances, blocked fallopian tubes, endometriosis, or abnormalities of the reproductive organs. Men can experience infertility if they have problems with the number and shape of their sperm, produce antibodies against their own sperm, or have blocked spermatic cords. In some cases, the exact cause of infertility cannot be explained.
Proper diagnosis of infertility will help in selecting a treatment plan that maximizes the chance of becoming pregnant.
In about one third of couples who have difficulty conceiving, male causes will be identified. The major cause of male infertility is failure to produce enough healthy sperm. This is investigated by analyzing a sample of the man's semen. A man is diagnosed as infertile if he produces too few sperm (20 million sperm per milliliter of fluid is considered the lower limit of male fertility) or his sperm may be abnormal in structure or motility (ability to move) and unable to reach or penetrate an egg.
If you and your partner are actively trying to conceive and have no results after a year, you should visit your doctor.
Different types of male infertility
There may be problems with ejaculation — either premature ejaculation or retarded ejaculation.
There may be a disorder affecting sperm production, varicoceles (varicose veins in the spermatic cord) or undescended testes.
Less common reasons include side effects of the treatment of testicular cancer, testicular damage from infections e.g. mumps or trauma or injury to the testes.
A man may have a rare genetic or hormone deficiency, which causes infertility.
A large number of patients are known to have no cause detected for their low count or motility grouped as Idiopathic Oligoastherospermia ( OAT)
During sexual intercourse, if ejaculation doesn't occur or not deposited enough semen into the vagina, the migration of sperm to the fallopian tubes may become increasingly difficult.
Premature, or rapid, ejaculation is the inability of a man to control delay ejaculation until his female partner has achieved orgasm.
Premature ejaculation is thought to be quite common but may not be so premature as to prevent conception.
Low sperm count
A low sperm count can result in difficulty in conceiving. It can be caused by a number of things, for example, an injury, radiation therapy (for cancer), excessive heat such as a fever, and certain medications. Anabolic steroids, like those used by some bodybuilders to build up their muscle bulk, are known to reduce a man's sperm count.
Cigarette smoking, excess alcohol and stress can also contribute to a low sperm count.
Sometimes the testicles produce a sufficient number of sperm, but these sperm are unable to 'swim'. They are said to be immotile. When the sperm are ejaculated into the vagina, they have to make their way to the mature egg by 'swimming' through the cervical opening, up the uterus, and into the fallopian tubes. Some sperm cannot make this journey. This may be due to a number of reasons; for example some drugs may affect a sperm's motility.
Some men produce antibodies to their own sperm, which prevent the sperm from penetrating the egg. The exact cause is not known but may be due to infection or vasectomy.
Spermatic cord occlusion
The spermatic cord is the tube that transports the sperm from each testis to the penis and any blockages will cause infertility. Common causes are tuberculosis, vasectomy, infection and other sexually transmitted diseases.
How can male infertility be treated?
There are a number of methods currently available and research is ongoing. Treatment will depend on the cause identified. Medication can be used to treat hormone deficiencies or infection.
In few selected cases Surgery may be considered if the vas deferens are blocked or there are varicoceles in the spermatic cord. Insemination of sperm into your partner’s cervix or uterus may work in cases of retrograde ejaculation (ejaculation into the bladder instead of the penis), premature or delayed ejaculation, poor sperm quality or low count, and unexplained infertility. If infertility is due to a prior vasectomy, reversal may be possible.
If the count is too low then IVF ( Test Tube Baby) or ICSI is and in cases of Nil Sperm either, surgical extraction of sperm from testes is suggested or sperm banking may also be tried to provide a viable outcome.
A delicate balance of sex hormones (oestrogen, progesterone, luteinizing hormone and follicle stimulating hormone) is needed for the timely growth and release of the egg from the ovary (ovulation).
Hormone imbalances can cause ovulation disorders in women and are the most common cause of infertility in women.